Normalizing Drug Use

The drug policy battle in the U.S. isn't about medical marijuana, or even legalizing marijuana.

It's about normalizing drug use.

Do drugs create different experiences from other involvements we are familiar with—are they more compelling, more inescapable, less controllable, more inexorable in their progression to addiction than other experiences that we encounter daily?

They are not.

Three theorists who make this point are Bruce Alexander, Carl Hart, and me.* Bruce shows that rats provided ordinary life alternatives in Rat Park (including, especially, the opportunity for sex) prefer these to continuing their habituated use of morphine solution. Carl shows that the supposedly inevitable negative effects of methamphetamines are overstated—as is obvious from their sharing a chemical structure with Adderall. As for crack, Carl describes in High Price his upbringing in a Miami ghetto prior to the crack epidemic—and how the drug had no substantial effect on the social pathology that predated the drug's appearance.

My argument in Love and Addiction was that people form extremely pathological involvements with a large number of powerful experiences (love and sex being the most prominent examples, but also including gambling, electronic games, eating, et al.). I (and co-author Archie Brodsky) meant by pointing this out that drugs did not have the special quality of "addictiveness." But, instead of recognizing this commonality between things we all know about and drug experiences, advocates for sex and love addiction (e.g., Benoit Denizet-Lewis) affixed the standard 12-step, loss-of-control meme to these other addictions. Rather than normalizing drug experiences, they pathologized non-drug experiences.

By and large, people don't accept Bruce's, Carl's, and my idea that drug responses fall in the range of normal human experiences, or my idea of the equivalency of drug and behavioral addictions (which is now the American Psychiatric Association's official position). (Please don't answer, "You don't mean physiologically addictive." See The Meaning of Addiction.) Americans carry too much cultural baggage to allow those ideas in. Instead, we think drugs—especially narcotics, and most especially heroin, followed by cocaine, crack and meth—are "truly" addictive. In fact, did you know cocaine was only declared addictive in the 1980s, after a century and more of experience with the drug?

Flash forward to the present, where an article in a major journal showed marijuana produced abnormal fMRI results in regular pot smokers.

Maia goes on to cite statistics from the 2012 National Survey of Drug Use and Health, in which fewer than one percent of Americans have a serious marijuana problem, although 48 percent have used marijuana in their lives. Why, that's less than two percent of everyone who has ever used the drug who abuse or are addicted to the substance currently.

That is so unlike dangerous drugs to which everyone rapidly becomes permanently addicted!

Here are the current abusers/addicts with these drugs: heroin (0.1 percent), cocaine (0.4 percent), crack (not listed), meth (only stimulants listed = 0.2 percent). So, for heroin, that's four percent of ever users who are addicted, and for cocaine about the same as for marijuana (around 2 percent). While meth and crack can't be calculated, the figure is clearly a small minority (less than 10 percent).

What are we to make of that? According to government surveys, people rarely find even the most addictive, dangerous drugs to be, well, addictive and dangerous. Please don't answer, "People don't tell the truth in government surveys." In their comprehensive follow-up of Vietnam vets addicted to heroin in Asia, Lee Robins and her colleagues found that users of heroin stateside were no more likely to consume that drug compulsively than were users of other illicit drugs. Based on this and other research, I said in The Meaning of Addiction, "heroin does not appear to differ significantly in the potential range of its use from other types of involvements, and even compulsive users cannot be distinguished from those given to other habitual involvements in the ease with which they desist or shift their patterns of use."

As I said there, "This book embraces rather than evades the complicated and multifactorial nature of addiction. Only by accepting this complexity is it possible to put together a meaningful picture of addiction, to say something useful about drug use as well as about other compulsions, and to comprehend the ways in which people hurt themselves through their own behavior as well as grow beyond self-destructive involvements."

I don't understand how Volker et.al can espouse the disease theory of addiction in the face of the empirical behavior evidence. fMRI finding measure blood flow not neural activity. As Dr. Peele notes dopamine is secreted in smiling babies.
I wonder if the disease theory is mainly a liberal mind set to promote the premise that, "We are all good boys and girls and should never be blamed for our behavior."

hi stanton, how do you understand that "About 90 percent of cigarette smokers become addicted before the age of 19, according to the CDC" if other addiction rates are so low and addiction is not based on chemicals, why do so many smokers become addicted as opposed to other drug users or alcoholics?

The machine-made cigarette is the most efficient drug delivery device ever created. (Think how much easier it is to smoke than to prepare a needle for injection.) Before that, ceremonial smoking in the Middle East (a la the hookah) or among Native Americans sharing a pipe made tobacco addiction difficult (impossible, in fact, for Native Americans, who have been vastly prone to other substance addictions).

That notwithstanding, when I speak to counselors, most of whom are recovering alcoholics/addicts, I ask: "What is the most addictive drug?"

They shout in unison, "nicotine" (or "smoking").

I say, "How many of you have overcome an addiction to tobacco?"

In the right groups, 60 percent of people will raise their hands.

"Wow," I say. "How many of you went to a doctor for a nicotine patch or gum or joined a support group to quit?"

From none to a handful raise their hands.

"You're too radical for me," I say. "More than half of you have quit the toughest drug addiction, and virtually none of you used a support group or treatment to do it."

Here are five facts off of that riff:

1. Unbelievably to most, a HIGHER percentage of drug addicts and alcoholics (about three quarters) quit their addictions than smokers (50%), and most (like smokers) do it on their own.

2. Although a majority of smokers still quit on their own, that percentage is constantly being whittled down by pharma marketing of drugs to quit in ads telling people that they can't quit on their own. (We're down from about 90% self-quitters to below 60%.)

3. As I describe in Recover!, data show that dependent smokers who quit using NRT (nicotine replacement) are MORE likely to relapse than those who quit themselves.

4. Although the standard wisdom is that addicted smokers can't cut back, AS A SOCIETY our smoking addiction has been cut back, now that people must delay to go outside to smoke (which most argued was impossible). The average number of cigarettes habitual smokers smoke today has dropped to 6 from 16 daily.

It says "as Ilse Thompson and I pointed out in Recover! Stop Thinking Like an Addict, measurable dopamine and fMRI responses are produced by every notable human experience, including seeing a baby smile."

I think it depends on the person, of course. I am extremely prone to compulsive behavior -- I've been through it with cleaning, dancing, drugs, candy and video games, to name a few. But drugs had a hold on me that nothing else could compare to. A day in a park with friends, and no drugs, sounded like a frightening trial for years, whereas a day alone, behind a trash bin, in the rain, high, sounded like paradise. I even thought most people felt the same and that they just didn't want to admit it. The only other form of entertainment that could come close to what drugs did to my free will was Tetris. Even other video games were just annoying, but Tetris was like being in a better world. Almost like being just slightly high. But not quite.

Of course, you really didn't clear anything up, because the only experience you likened to drugs was a game -- and DSM-5 specifically declined to include gaming on the addiction "list" (it's on the "to do" list).

Oh, and the other thing you didn't get into was when you got off drugs.